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Among the changes Senate Democratic leaders made to the massive health care package unveiled Saturday was giving nonprofit health insurance companies a limited exemption from the excise tax levied on insurers, a revision pushed by Sen. Carl Levin, who is a major recipient of campaign contributions from mega-nonprofit Blue Cross Blue Shield.

The excise tax, or fee, on health insurance companies was expected to bring in $6.7 billion to help pay for the nearly $1 trillion bill, but the exemption for nonprofits won by Mr. Levin, Michigan Democrat, could cut the revenue by as much as half.

It was unclear Saturday how the exemption would affect the cost of the bill or how many nonprofits would qualify for the exemption, attained by spending a high enough percentage of revenue on health services. However, the language appeared to clearly protect Blue Cross Blue Shield of Michigan from the fee.

Mr. Levin said the bill should “distinguish between the true nonprofit insurance companies and most profitable insurance companies in the country, and I’ve been working to fix that because I think that distinction is important.”

Nonprofit health insurers - which insure about 45 percent of Americans and include multistate companies such as CareFirst Inc. and Health Care Service Corp. - are virtually indistinguishable from their for-profit competitors.

The insurance premiums paid to nonprofits are often as high as those paid to for-profit insurance companies. Top executives at nonprofits also take home paychecks just as huge as those of their for-profit counterparts.

Federal Elections Commission data show Mr. Loepp also gave Mr. Levin’s campaign committee $3,000 in the course of the 2007 and 2008 election cycles.

Mr. Levin’s top campaign contributor from 2005 into the 2010 election cycles was Blue Cross Blue Shield, with total contributions of $48,000 from its employees and its political action committee, according to campaign finance data from OpenSecrets.org.

Mr. Levin originally drafted the exemption language as an amendment to the health care bill. But the language was added as Senate Majority Leader Harry Reid, Nevada Democrat, wrote the final package behind closed doors.

The No. 2 Senate Democrat, Richard J. Durbin of Illinois, said he supported the exemption because nonprofits deserve a break.

“They are nonprofits for a reason. They are trying to keep the cost of health care down,” he said.

The legislation is intended to expand health care coverage to millions of uninsured Americans, guarantee coverage by prohibiting the denial of insurance due to pre-existing medical conditions and hold down skyrocketing health care costs.

Critics of the exemption say the nonprofits would be granted an unfair advantage in the insurance marketplace, as the excise tax pushes up the cost of doing business and premiums at for-profit insurance companies.

The Congressional Budget Office concluded that the cost of the excise tax likely will be passed on to business and individual consumers in the form of higher premiums.

Consumers in states where the health insurance market is dominated by for-profit companies would pay higher premiums than people in states where most get coverage from nonprofits.

In Georgia, 91 percent of residents get health insurance from for-profit companies. In Nevada and Maine, it is 87 percent and in Ohio 85 percent, according to health industry analyst HealthLeaders-Interstudy.

Those states’ consumers could end up with higher premiums than those in Minnesota, where 91 percent are insured by nonprofits, or Michigan, where 76 percent use nonprofit companies.

A legal analysis of the Levin amendment for Wellpoint Inc. cited a potential violation of the Constitution’s uniformity clause that commands that “all duties, imposts and excises shall be uniform throughout the United States.”

Rather than applying the tax uniformly across the country, the exemption would cause the excise tax’s application and effect to vary greatly from state to state, said a memo to Wellpoint by the law firm Akin Gump Strauss Hauer & Feld.

The Washington Times obtained a copy of the memo.

Blue Cross Blue Shield Association, the lobbying arm of the health insurance companies, did not respond to a request for comment.